That's especially true in farm country. According to recent medical research, rural Americans are more likely than their urban counterparts to be diagnosed with high blood pressure, diabetes, heart disease, and obesity. But urban Americans enjoy access to more than double the amount of medical specialists per patient than those in rural areas.
Health care, of course, is vitally important to 35 million Americans aged 65 and older. And this week, Senator Charles Grassley held a series of town hall meetings in his home state of Iowa -- the nation's 4th oldest state -- to listen and respond to his constituency. But unlike similar gatherings elsewhere in America, the Iowa exercises in civic discourse were, for the most part, civil. Andrew Batt explains.
Sen. Charles Grassley, R-Iowa: "This is my 2,846 town hall meeting."
Market to Market followed Grassley for 10 hours Tuesday from rural churches to community centers to small town parks – where he conducted town hall meetings on health care reform. But as Iowa's senior senator quickly discovered… congressional recess this August is anything but a vacation.
Male Town Hall Attendee: "Social Security is broke. Medicare is broke. Even the post office is out of money. How can we trust the government with anything?"
Sen. Charles Grassley: "Not enough people come to town meetings. If we had more people that were fearful for their country we'd be better off."
Male Town Hall Attendee: "When you vote for a plan will you agree today to accept that health care plan as your own?"
Sen. Charles Grassley: "Well, as I've said before. I'm not going to vote for a bill that puts the government in charge of health care."
An overflow crowd forced Grassley's morning town hall in Winterset, Iowa to move from inside the public library to outdoors. The four-term Senator spent much of the hour-long Q-and-A session defending his seat at the health care reform table.
Grassley: "I'd rather be at the table then outside looking in…"
Despite pointed questions, Grassley's town halls were relatively calm compared to those conducted by some of his congressional colleagues. In Pennsylvania this week, Democratic Senator Arlen Specter faced a more combative audience armed with moral admonitions.
Protestor: "One day, God's going to stand before you, and he's going to judge you and the rest of your damn cronies up on the Hill! And then you will get your just desserts. I'm leaving."
Sen. Arlen Specter, D-Pennsylvania: "OK, OK, OK, we've just -- we've just had a -- we've just had a demonstration of democracy."
Back in Iowa, Grassley took a handful of heated questions in stride. The veteran Republican is one of six lawmakers crafting a bi-partisan health measure in the Senate Finance Committee – a bill he believes faces an uncertain future.
Sen. Charles Grassley, R-Iowa: "We left it with a work in progress. As far as we Republicans are concerned - no deadline. As far as Chairman Baucus is concerned, then September 15."
While many of the attendees in Winterset opposed any health care reforms, one visitor embracing change took issue with Grassley's comments.
Kate Bason, Madison County, Iowa: "Grassley's talking about how all of this is public health care that is going to take away all of our lives. Think about what our taxes get us. They get us clean water, good roads, social security that a lot of people count on. Medicare is socialized and most people are very happy with Medicare."
Grassley took his rural tour next to a packed Methodist Church in Afton, Iowa where one resident argued a health care overhaul was "too much change."
Male Town Hall Attendee: "If we only have 10 percent of a problem here why don't we fix that 10 percent instead of overhauling a system that affects all of you people!"
Grassley: "If a comprehensive program doesn't go through then you will find some incremental changes along what you are suggesting. More of a rifle shot approach than a shotgun approach."
Woman up front: "I'd like to have you know you are in our thoughts and prayers because I think this country really needs it. Step by step there is an overtaking of the freedoms and choices in this country."
Grassley: "Everyone should pray for their elected officials. I told the President one day at lunch that I pray for him."
Grassley's private meetings with President Obama are more than a customary gathering with a veteran Republican from Rural America. The White House targeted Grassley early this spring as a potential "YES" vote on health care reform – an increasingly rare opportunity to snatch Republican support. But that opening may be shrinking…
Just this week, President Obama mentioned Grassley as a key swing vote.
President Obama: "There are some Republicans I really respect working on this bill…Senator Grassley is one of them."
Presidential praise notwhithstanding, Grassley voiced skepticism that health care reform could pass in the U.S. Senate. And at his third town hall meeting of the day, the Iowa Republican included a controversial statement.
Grassley: "Even though I'm talking and have been for months about health care reform, things could fall apart tomorrow. I don't want government deciding whether Grandma should live or not live."
Grassley's reference that current legislation amounts to "pulling the plug on Grandma" drew large cheers from the nearly 300 Iowans in attendance. But the claim has been widely debunked by independent organizations. According to non-partisan, politifact,com, the so-called, end-of-life care in a House-passed version of reforms would encourage doctors to discuss options for elderly patients such as living wills and would not amount to euthanasia for America's oldest citizens.
Woman: "You know there is nothing in the House bill for you to stand before a committee and decide whether you live or die."
Grassley: "If you go to a Canadian-style health care plan and then everybody starts studying what England does...
Woman: "But you know that's not what they are asking for."
Grassley: "When you couple this with all the other fears then you get the idea that Grandma's lived too long."
Grassley's reference received widespread coverage and condemnation from proponents of health reform. But many in the Panora audience want their U.S. Senator and Washington to put the brakes on any reform.
Billy Hummel, Adel, Iowa: "I'm glad these issues are coming to a head. I'm glad there are discussions but I hope it ends in a stalemate. Because we don't need more debt and that is the only way to pay for this."
Skepticism of government programs was clearly evident at the Senator's last town hall of the day in Adel, Iowa.
In front of more than 400 residents, Grassley argued he was "doing the right thing" as one of a handful of Republicans even speaking to Democratic leadership on health care.
Grassley: "Sometimes I feel like I'm the little boy with his finger in the dike trying to prevent the dam from breaking."
Male Town Hall Attendee: "Where does it say in the constitution that the government has the ability to regulate health care?"
Grassley: "Well it's not in there. That's why we need to keep the government out of there."
While Grassley's town hall forums largely represented a push-back on health care reform, the Iowa Senator said at least one policy option is still alive.
Andrew Batt: "One of the policy discussions early on was a cooperative option. Is the Coop option dead?
Grassley: "No I don't think it is. And I think that is good and it could be understood by the people of Rural America who are very used to coops. We don't need further government involvement in health care."
After more than 10 hours of town hall meetings, Grassley's future role in health care reform remains unclear. Only time will tell if the conservative 28-year Senate veteran becomes the ultimate swing vote. For the time being, he savors his status as "The Man in the Middle."
For Market to Market, I'm Andrew Batt.